Provider Demographics
NPI:1770659138
Name:JEREMIAH N. O'DWYER, DDS, LLC
Entity Type:Organization
Organization Name:JEREMIAH N. O'DWYER, DDS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEREMIAH
Authorized Official - Middle Name:N
Authorized Official - Last Name:O'DWYER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:860-643-6992
Mailing Address - Street 1:15 MIDDLE TPKE W
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040-4045
Mailing Address - Country:US
Mailing Address - Phone:860-643-6992
Mailing Address - Fax:860-645-1882
Practice Address - Street 1:15 MIDDLE TPKE W
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-4045
Practice Address - Country:US
Practice Address - Phone:860-643-6992
Practice Address - Fax:860-645-1882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2012-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0081571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty